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Veterinary Pharmacology > Smalltest nr 3 > Flashcards

Smalltest nr 3 Flashcards

1
Q

Painkilling list

A
  1. Opioids
  2. NSAIDS
  3. ⍺-2 agonists
  4. Antibodies against nerve growth factor
  5. Gabapentin
  6. Antidepressants
    + KETAMIN (NMDA receptor antagonist)
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2
Q

Gabapentin used for (indication)

A
  1. Anti epileptic
  2. Unique for NEUROPATHIC PAIN
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3
Q

What are the major pilars due to painkilling?

A
  1. Opioids
  2. NSAIDS
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4
Q

Name an NSAIDS agianst headache

A

ASPIRIN

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5
Q

What are the requirements for surgery

A

General Anaestesia

  1. Total unconsciousness
  2. Total muscle relaxation
  3. Total analgesia

NOT= ANALGESIA or NEUOROLEPTIC

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6
Q

What is balanced anesthesia?

A

Balanced anesthesia - GS reached with combinations of drugs
Eg. ⍺-2 agonists with:
1. KETAMIN
2. BUTORPHANOL = Opioid
3. XYLAZINE - Emesis induction - cat - Subsedative dose

Used for predemication, induction and wide maintenance

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7
Q

BUTORPHANOL
Type of drug

A

Opioid

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8
Q

KETAMIN
Type of drug

A

NMDA receptor antagonist

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9
Q

Opioids and analgesia?

A

VERY POTENT ANALGESIC

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10
Q

Higher dose of Xylazine or Detomidine cause analgesic effect?
True or false

A

True
The higher dose of Xylazine or detomine, the more POTENT analgesic effect of the ⍺-2 agonists substance!

Induces painkilling effect of the other substances.

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11
Q

What are the different tests performed to evaluate pain and pain perceptions?

A
  1. Tail flinch test
  2. Hot plate test
  3. “Sigmund” (Wrighting) test
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12
Q

Characterize the Tail flinch test

A
  1. Lab animals is used
  2. At least 2 groups.
    - One is placebo
  3. Focused infra red light
    - heat up tissue of tail = causes pain within seconds!
    - Mouse will pull away the tail.
  4. Measure the time
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13
Q

Characterize the Hot plate test

A
  1. Easier to measure than tail flinch test
  2. Hot plate heated to 54 degrees celsius
  3. Measure the time until mouse lift up its feets to lick its foot.
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14
Q

Tail flinch latency graph

A
  • Measure tailflinch with and withouth painkilling subst.
  • Administration route is important - IV or IM
    1. Using MORPHINE
    (GA, premedication or during maintenance)
  • Wait 20-30 min!! Time to reach morphines maximal painkilling activity! Before that not enough painkilling effect if you use MORPHINE alone as a painkiller.
  • In surgery, wait 20-30 min prior to cut the animal
  • Compared with the control group = Proove of painkilling effect! = By having morphine In the system, they can endure pain for more seconds (3 sec)
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15
Q

Characterize the WRIGHT (SIGMUND) test

A
  1. NO LONGER USED because of animal welfare
  2. Measure number of convulsions
  3. Use substance to induce pain (Algogenic, 1% acid)!
  4. Given IP = VERY PAINFUL
    - As PANCREATITIS!!! And PERITONITIS!!!
  5. Due to convulsions you will be able to detect a time dependent efficacy
  6. ⍺-2 agonists -> detomidine > xylazine in regards of potency, ↑dose = ↑ potency
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16
Q

Detomidine VS Xylazine due to convulsions and analgesic effect

A

DETOMIDINE is a more POTENT ANALGESIC, so less convulsions will be seen compared to Xylazine.

↑dose = ↑ potency

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17
Q

Druggroups used as premedications prior to GA

A
  1. PHENOTHIAZINES
  2. BUTYROPHENONES
  3. ⍺-2 AGONISTS
  4. BZD (BENZODIAZEPINES)
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18
Q

Name the Tranquilizer groups

A
  1. PHENOTHIAZINES
  2. BUTYROPHENONES
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19
Q

Characterize the TRANQULIZER drug group

A
  1. Used for Traveling
  2. Cause Sedation ONLY (Level of CNS depression)
  3. ↑dose = ↑ duration
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20
Q

Name the Sedatohypnotic drug groups

A
  1. ⍺-2 AGONISTS
  2. BZD (BENZODIAZEPINES)
  3. Phenobarbital=Barbiturates
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21
Q

Characterize the Sedatohypnotic drug group

A
  1. Not enough for surgery on its own
  2. ↑ High dose = Hypnosedation, Low dose = Sedation
    (level of CNS depression)
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22
Q

PHENOTHIAZINE
Drugs

A

= Tranquilizers
Acepromazine

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23
Q

BUTYROPHENONES
Drugs

A

= Tranqulizers
AZAPERONE
DROPERIDOL
FLUANISONE

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24
Q

Characterize the GA drug group

A
  1. Cause the debth enough of CNS depression to cause general anesthesia!
  2. Inhalations and Injections
  3. Elevation of dose on the graph indicates that it needs to be monitored => Danger of EUTHANASIA!
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25
Q

⍺-2 AGONISTS
Drugs

A

XYLAZINE
DETOMIDINE
MEDETOMIDINE
DEXMEDETOMIDINE

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26
Q
  1. BZD (BENZODIAZEPINES)
    Drugs
A

DIAZEPAM
MIDAZOLAM
(Alprazolam)

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27
Q

PHENOTHIAZINES
(Acepromazine)
Sedation

A

Yes + (++)

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28
Q

PHENOTHIAZINES
(Acepromazine)
Analgesia

A

No analgesic effect, however, it potentiates the analgesic effect of other drugs

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29
Q

PHENOTHIAZINES
(Acepromazine)
Administration route

A

IV, (IM)
Po -> bioavailability is unreliable (individual independent)
Acepromazine NOT reliable ORALY

Oral DOG and HORSES - for sedate for minor procedure or transport to practice - one will have an effect and other not

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30
Q

PHENOTHIAZINES
(Acepromazine)
Indication

A
  1. Transportation (calming),
  2. Premedication,
  3. Neuroleptic-analgesia (NOT for GA)

Acepromazine -> used to fight histamin effect
= antihistamine
UNIQUE INDICATION (morphine cause histamine release, use acepromazine to avoid this)
4. Anti-emesis = anti vomit - motion sickness

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31
Q

PHENOTHIAZINES
(Acepromazine)
Side effects

A
  1. Hypotension (⍺-1),
  2. penile prolapse (eq),
  3. 3rd eyelid prolapse (ca, fe),
  4. ↑ Pseudopregnancy duration (ca),
  5. Thermoregulation = lost (esp. acepromazine)
  6. Tissue irritant
  7. Can be paifull IM
  8. In small animals - Decreased GI activity
  9. Tympanism (ru)
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32
Q

PHENOTHIAZINES
(Acepromazine)
Contraindications

A
  1. Dehydration (⍺-1 -> hypotension),
  2. history of epileptic seizures, advised not to use
  3. Ulcers
  4. ACEPROMAZINE NOT for BOXERS
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33
Q

BUTYROPHENONES
Sedation

A

Yes + (++)

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34
Q

BUTYROPHENONES
Analgesia

A

No analgesic effect, however, it potentiates the analgesic effect of other drugs
- Slightly analgesic in comparance to acepromazine

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35
Q

BUTYROPHENONES
Administration route

A
  1. IM only
    (due to ⍺-1 agonist, it can cause hypotension so severe, that patient can collapse)
  2. AZAPERONE - Swine - reduce stress traveling = ONLY ORAL
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36
Q

BUTYROPHENONES
Indications

A
  1. Transportation (calming),
  2. premedication,
  3. neuroleptic-analgesia (butyrophenones -> combine with opioids -> provides muscle relaxation, sedation & mild analgesia) = ONLY MINOR PROCEDURES not GA
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37
Q

What is Neuroleptic-analgesia

A

Tranquilizers + opioids
Butyrphenones + opioids
Especially used in EXOTIC ANIMALS

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38
Q

BUTYROPHENONES
Sideeffects

A
  1. Hypotension (⍺-1),
  2. penile prolapse (eq),
  3. 3rd eyelid prolapse (ca, fe),
  4. increase pseudopregnancy duration (ca),
  5. thermoregulation = lost (esp. acepromazine)
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39
Q

BUTYROPHENONES
Contraindications

A
  1. Dehydration (⍺-1 -> hypotension),
  2. History of epileptic seizures,
  3. Butyrophenones have a LONG duration(halflife) =Ø use for transport! Not allowed for slaughter-transport?
40
Q

Indication
Droperidol
Fluanisone

A

Other than sedation due to examination or transport (tranquilizers)
Used as premedication prior to surgery

41
Q

⍺-2 AGONISTS
Sedation

A

Yes
+++

42
Q

⍺-2 AGONISTS
Analgesia

A

+++
Yes

43
Q

⍺-2 AGONISTS
From least -> most selective
meaning

A
  1. Xylazine
  2. Detomidine
  3. Medetomidine
  4. Dexmedetomidine

Meaning that:

  1. Xylazine is the least selective = most side-effects
  2. Dexmedetomidine is the most selective = least side-effect and is also alowed in cardiac patients.
44
Q

⍺-2 AGONISTS
Administration Route

A

IM, IV
Po -> no swallowing!!
Absorption via buccal application (gel) - DEXMEDATOMIDINE (Ca, Fe)

45
Q

⍺-2 AGONISTS
Indications

A
  1. Alone -> minor procedures
    (e. g. ear cleaning, wound bandaging)
  2. Combo
    -> e.g. with ketamine -> balanced anaesthesia
    Fe -> xylazine = emesis (subhypnotic dose)
    Combination to later perform GA
46
Q

⍺-2 AGONISTS
Side effects

A
  1. Vomiting, emesis,
  2. SIDE effects due to ⍺-1 agonism

-> Ø heart failure patients
(dexmedetomidine can be used in heart failure patients), –> Ø diabetic patients because it can increase glucose blood levels

Sideeffects depending on the SENSITIVITY of the ⍺1 or ⍺2 receptor

47
Q

⍺-2 AGONISTS
Contraindications

A

Cardiac failure patients, diabetic patients
(dexmedetomidine can be used in heart failure patients),

48
Q

BDZ
Sedation

A

(Diazepam, midazolam)
Yes, +
Depending on the dose and indication

49
Q

BDZ
Analgesia

A

(Diazepam, midazolam)
No —

50
Q

BDZ
Administration rout

A

IV
Intranasally, IV, rectally
IM -> not reliable for diazepam
(midazolam IM absorption is good enough)
Po -> alprazolam (xanax; used for phonophobia (ca)

51
Q

BDZ
Indications

A
  1. Premedication,
  2. sedation & hypnosis,
  3. anticonvulsant (status epilepsy),
    fe-> diazepam is used to increase appetite
    (short term, because it can cause irreversible liver damage) Not longer than 5-7 days!
52
Q

BDZ
Side effects

A

Hepatotoxic, weight gain

53
Q

BDZ
Contraindication

A

Fe & usage of diazepam

54
Q

Phenobarbital
Sedation

A
55
Q

Phenobarbital
Analgesia

A

No
- -

56
Q

Phenobarbital
Administration route

A

Po, maybe IV

57
Q

Phenobarbital
Indications

A

Long term management of epilepsy

58
Q

Phenobarbital
Side effects

A
  1. Weight gain,
  2. hepatotoxic,
  3. CYP450 inducer!!
    (speeds up the metabolism of itself and other drugs metabolized by cytochrome enzymes => increase the dose)
59
Q

Phenobarbital
contraindications

A

Not 1st choice in liver failure patients

60
Q

Morphine, fentanyl
Category

A

Full agonist

61
Q

Morphine, fentanyl
Analgesic potency

A

+++

62
Q

Morphine, fentanyl
Sedation

A

++

63
Q

Morphine,
Duration of action

A

Morphine - 3-4 hrs
Give continuous rate infusion
(can govern anesthesia a lot safer)

64
Q

Fentanyl
Duration of action

A

Fentanyl - bolus = 20-30 min
Give continuous rate infusion
(can govern anesthesia a lot safer)
For injectable anaesthesia - fentanyl

65
Q

Morphine, fentanyl
Side effects

A
  1. Respiratory depression,
  2. emesis, (depends on the drug)
  3. histamine release (acepromazine use to counter this), 4. anti-diarrhea,
  • apomorphine (eyedrops, SC) -> very strong emesis effects… wear gloves or wash hands STORY, injections
66
Q

Use of bolus in such as fentanyl

A

Bolus -> the administration of an amount of drug given at once (for fentanyl, must then readminister every 20 min)

67
Q

Drugs belonging to OPIOIDS

A
  1. Morphine
  2. Fentanyl
  3. Tramadol
  4. Buphrenorphine
  5. Butorphanol
68
Q

Indication of opioids

A
  1. Pain killing effect
  2. Used for its side effects
    - Emesis = APOMORPHINE
    - Anti-diarrhoea = LOPERAMIDE
69
Q

Drug used to induce emesis

A

APOMORPHINE

70
Q

Drug used for anti-diarrhoea

A

LOPERAMIDE

71
Q

Tramadol
Category

A

Partial Agonist

72
Q

Tramadol
Sedation

A

No -

(however, long term Po, the patient can appear sedated)

73
Q

Tramadol
Analgesic potency

A

+

74
Q

Tramadol
Duration of action

A

6-8 hours

75
Q

Tramadol
Side effects

A
  1. Respiratory depression,
  2. emesis,
  3. histamine release
    (acepromazine use to counter this),
  4. anti-diarrhoea,

apomorphine (eyedrops, SC) -> very strong emesis effects… wear gloves or wash hands

76
Q

Buprenorphine
Category

A

Partial agonist

77
Q

Buprenorphine
Analgesic potency

A

++

78
Q

Buprenorphine
Sedation

A

+
(dependent on dose & individual)
Moderatly

79
Q

Buprenorphine
Duration of action

A

6-8 hrs (can be up to 12 hrs) = Half a day
BID
1st choice in case of PANCREATITIS
= Because NSAIDS is not allowed

80
Q

ButorPhanol
Category

A

Partial agonist

81
Q

Butorphanol
Analgesic potency

A

+

82
Q

Butorphanol
Sedation

A

+
(dependent on dose & individual)
Moderate

83
Q

Butorphanol
Duration of action

A

3-4 hrs

84
Q

Butorphanol
Side effects

A
  1. Respiratory depression,
  2. emesis,
  3. histamine release (acepromazine use to counter this), 4. anti-diarrhoea,

apomorphine (eyedrops, SC) -> very strong emesis effects… wear gloves or wash hands

85
Q

Due to analgesic potency in which order does the mentioned opioids come in

A
  1. Morphine, Fentanyl
  2. Buprenorphine
  3. Tramadol/Butorphanol
86
Q

Situation task I.
Dog with heartworm disease
5 years old, slightly decompensated heart failure
Melarsomine: sedation-analgesia necessary What should we give?

A

Keywords:

  1. Heartworm disease,
  2. Slightly Decompensated heart failure

With heartworm disease, there are 2 ways to administer medicine:
A) slow;
B) complex therapy (fast)
-> use when patient has decompensated heart failure

MELARSOMIDE (immiticide)
-> sedation-analgesia is necessary (it is very painful!)

What to give?
Benzodiazepine & opioids (combined)

87
Q

When do we use the complex (fast theraphy) in case of heart worm disease?

A

use when patient has decompensated heart failure

88
Q

When performing complex (fast) therapy in case of Heartworm disease, which drug is used?

A

MELARSOMIDE (immiticide) = Arsenic compound

  • > sedation-analgesia is necessary (it is very painful!)
  • > Given IM into Lumbar Muscle
  • > While Sedated
89
Q

What to give together with the painful MELARSOMIDE (immiticide) ?

A

No need for general anesthesia
BENZODIAZEPINE(BZD) & OPIOIDS (combined)

-> sedation-analgesia is necessary because MELARSOMIDE is really painful

90
Q

Situation task II.
Dog with severe trauma
Stabile general condition (3 years old, no known disease) Amputation inevitable
Which drugs should we use for premedication?

A
  1. Phenothiazine
  2. ⍺-2 agonist
  3. Benzodiazepines
  4. Ketamine
  5. Lidocaine
91
Q

Situation task II.
Dog with severe trauma
Stabile general condition (3 years old, no known disease) Amputation inevitable
Which drugs should we use for premedication?
WHY do we use them?

A
  1. Phenothiazine
    - > potentiate the analgesic effect
    - > Acepromazine
  2. ⍺-2 agonist
    - > increase painkilling efficacy
  3. Benzodiazepines
    - > can prevent pre & post-anesthesia excitement
    - > Used as premedication as well
  4. Ketamine
    -> IV & has an analgesic effect (NMDAr antagonist), given at continuous rate (at subanesthetic dose), decreases sensitization of pain
    = Injectable anesthetic with IMPORTANT ANALGESIC effect
  5. Lidocaine
    - > local anesthetic, use around nerve where you’re going to cut the leg off
92
Q

Why does pre and post narcotic excitation happen?

A

During General Anesthesia
- pre and post excitatation can happen depending on the individual, the drug, and the combination of the drug

93
Q

How to avoid pre and post narcotic excitation?

A

Mostly we can avoid this pre and post narcotic excitation. Prevented mostly by Benzodiazepines..

94
Q

Characterize KETAMIN

A

Decrease the sensitization to pain
Act on the NMDA receptor
Used in combination with ⍺-2 agonist in order to perform balanced anesthesia

95
Q

Which type of drug cannot be used in diabetic patients

A

⍺-2 agonists

Because it can increase blood glucose level

96
Q

Which type of drug cannot be used in cardiac failure patients? With the exception of one drug.

A

⍺-2 agonist

Dexmedetomidine can be used in heart failure patients (gel-buccal)

97
Q

Sideeffects of the ⍺-2 agonist depend on

A

The sensitivity of the ⍺1 and ⍺2 receptor

Veterinary Pharmacology (21 decks)

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